Page 72 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

Children undergo GP for a wide variety of indications. The majority of children in our cohort suffered from NI (68%). It is well known that these children often suffer from generalized gastrointestinal dysmotility.19,20 This may have resulted in slower GE in NI children compared to NN children in our cohort. For this reason we performed a subanalysis of NI children alone. It indeed showed a higher GE percentile before operation. However, after operation the delay in GE was similar (both NI and NN made an increase of 22 percentile-points).
Unfortunately, we were unable to identify preoperative predictors of gastrostomy failure. The number of patients with gastrostomy failure (n=12) was too low to perform multivariable analysis. The occurrence of gastrostomy failure might be multifactorial or dependent on factors not included in our univariable analysis.
To our knowledge, no previous study has identified predictors of gastrostomy failure in children. However, two studies attempted to identify predictors of all minor gastrostomy- related complications (including e.g. hypergranulation and stomal infection). The first study identified no significant predictors. 6 The other reported a higher frequency of complications in patients with cardiac malformations (n=17). 5 Future research dedicated to this subject may provide us with more insight into risk factors for complications after GP.
A limitation of this study was that 11 postoperative 13CGEBTs were missing. In order to maintain adequate statistical power, we performed multiple imputation analysis on 13CGEBT results. Analysis of the imputed data yielded results similar to those of the original data. This suggests a random missing of the postoperative 13CGEBT, therefore making a bias on the effect sizes less probable.
In conclusion, this is the first study that demonstrates a delay in GE after a GP in children. Patients with a normal preoperative GE have a 50% chance of developing DGE after GP. DGE after GP is associated with GER and is found in most patients with postoperative leakage and feeding intolerance. Although gastrostomy failure could not be predicted with preoperative data, the negative effect of GP on GE and its possible consequences should be taken into account when this operation is considered in pediatric patients.
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